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Opioid safety: striking the right balance
  1. David Erskine, DTB Associate Editor,
  2. Steven Wanklyn, Consultant pharmacist in palliative and end of life care
  1. Department of Pharmacy, Guys & St Thomas NHS Foundation Trust, London, UK
  1. Correspondence to Mr David Erskine, Pharmacy, Guys & St Thomas NHS Foundation Trust, London, UK; david.erskine{at}

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The National Institute for Health and Care Excellence’s (NICE) draft guideline on the assessment and management of chronic pain states that opioids should not be offered to manage chronic primary pain.1 NICE found no evidence on the effectiveness of opioids for chronic primary pain and evidence from non-randomised studies on the long-term use of opioids suggested an increased risk of dependence. This advice and warnings of dependence are entirely appropriate and the overall message from NICE about the need for a fundamental review of the pharmacological management of chronic pain in adults has been previously welcomed by DTB.2

In September 2020, the Medicines and Healthcare products Regulatory Agency (MHRA) issued a national safety alert on the use of opioids for non-cancer pain.3 The recommendations were based on the findings of the Commission on Human Medicines’ …

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  • Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).

  • Provenance and peer review Commissioned; externally peer reviewed.